Southern California -- this just in

The Beverly Hills fertility doctor who assisted Nadya Suleman in conceiving octuplets in 2008 mostly followed "standard" procedure from the time he started treating her a decade earlier, according to a doctor who testified on his behalf Wednesday at a state medical board hearing.

Dr. Michael Kamrava's medical license could be revoked if it is determined that he was grossly negligent in his treatment of Suleman and two other female patients: a 48-year-old who suffered complications after she became pregnant with quadruplets and a 42-year-old diagnosed with advanced ovarian cancer after receiving fertility treatments.

Steinberg said he spoke with Kamrava and reviewed his records. He said he found the records justified Kamrava's aggressive treatment of Suleman because she had fertility problems and Kamrava had a low success rate at getting patients pregnant. Those aggressive treatments included implanting Suleman with six embryos in 2006, when she became pregnant with twins.

In January 2008, Kamrava implanted Suleman with eight embryos, a decision Steinberg said was unusual. Suleman did not become pregnant at the time, and Steinberg said there is no generally accepted standard for the number of embryos that should be implanted.

"He was trying very hard to help this woman get pregnant. I can't fault his judgment," Steinberg said. "I can question maybe how aggressive he can be, but again, I wasn't in the room with the patient."

In all, Kamrava helped Suleman conceive six children before the octuplets. He has testified that he recommended implanting four embryos in July 2008, or using embryos Suleman had already frozen, but she disagreed and he acquiesced to implanting 12 embryos.

Steinberg has not yet testified about Kamrava's decision to implant the dozen embryos.

But Steinberg, who has been practicing for 35 years and treats 200 to 480 patients annually, said many of his patients want to become pregnant with multiple babies in order to have large families.

"In our eyes, those embryos belong to the patients and they have to make decisions about them," Steinberg said.

Kamrava has said he counseled Suleman about reducing the number of fetuses and attempted to follow up with her after she became pregnant, but was unable to reach her.

"Fetal reduction remains as our safety net with in vitro fertilization," Steinberg said. "We counsel them in advance about options and alternatives and ways to manage, and that’s essentially what went on here.”

Three other doctors testified at hearings in the case last month.

Dr. Parviz Daniels, a general surgeon at Cedars-Sinai Medical Center, testified that he worked with Kamrava for years and "never heard anything negative" about him. Dr. Suraj Achar, associate professor of clinical medicine at the UC San Diego School of Medicine, conducted a daylong visit to the fertility doctor's office on short notice and described Kamrava as "remorseful."

But Dr. Victor Y. Fujimoto, director of UC San Francisco's in vitro fertilization program, testified for the state that Kamrava repeatedly failed to screen Suleman for mental health issues or limit the number of embryos she had implanted or frozen.

The state may present additional witnesses, followed by closing arguments, which are expected to start Thursday. Suleman and the other two patients are not expected to testify.

After Thursday's hearing, Judge Juarez is expected to submit his opinion to the state medical board, which will make the final decision about whether Kamrava can continue practicing medicine in California.

-- Molly Hennessy-Fiske

Photo: Dr. Michael Kamrava at a hearing before the state medical board last month in Los Angeles. Credit: Mark Boster / Los Angeles Times